The Prevalence of Adrenal Cortical Hyperplasia at Autopsy and Its Association with Hypertension

Review of the autopsy indexes of the Johns Hopkins Hospital, Baltimore, Md., between 1889 and 1966 provided 180 cases of adrenal cortical hyperplasia among 35,000 examinations (0.51%). The total prevalence of adrenal cortical hyperplasia at autopsy increased with age, and the age-adjusted prevalence among negro males exceeded (P < 0.05) that of the other race-sex groups. A highly significant excess (P < 0.001) of all forms of hypertension was found in the cases compared with carefully matched controls. Males tended to contribute more significantly (P < 0.01) than females (P < 0.025) to the excess. An excess of essential hypertension significant at the 5% probability level was found in the total case series. Further analyses by race of cases and controls showed that recognized secondary forms of hypertension correlated significantly (P < 0.025) with the cases in whites; whereas "essential" accelerated hypertension correlated significantly (P < 0.025) with the cases in negroes. Unequivocally documented Cushing's syndrome was found in seven of the cases and in none of the controls (P < 0.025). The excess of essential and essential-accelerated hypertension among the cases could not be accounted for by the presence of nonbasophilic pituitary adenomas, use of benzothiadiazine diuretics, concommitant renal disease, or carcinomatosis.